HHC Health & Home Care Clinical Policy And

HHC HEALTH & HOME CARE Section: 9-8
Infusion Therapy: Midline Catheter Insertion __RN
PURPOSE:
To provide guidelines for the insertion of a midline
catheter for the purpose of providing a reliable venous
access for infusion therapy.
CONSIDERATIONS:
1. The insertion of a midline catheter shall be
performed by an RN meeting the following
requirements:
a. Designated agency IV nurse.
b. Evidence of knowledge and competency in the
care of central venous access devices.
c. Successful completion of an agency approved
class for the insertion of midline catheters.
d. Observed competence in performing actual
insertion in a live subject by a qualified
instructor or preceptor.
2. Patients meeting the following criteria may be
considered candidates for the insertion of the
midline catheter:
a. Objective Data:
(1) Lack of short-term peripheral venous
access sites, length of therapy, multiple
therapies, pain management and hydration.
(2) Infusion of hyper-osmolar solutions.
(3) Infusion of non-vesicant chemotherapeutic
agents.
(4) Infusion of potentially sclerosing,
concentrated drugs.
(5) Infusion of blood and/or blood products.
(6) Therapies not appropriate for midline
catheters include continuous vesicant
chemotherapy, parenteral nutrition formula
exceeding 10% dextrose and/or 5%
protein, solutions and/or medications with
pH less than 5 or greater than 9, and
solutions and/or medications with
osmolarity greater than 500 mOsm/l.
b. Subjective Data:
(1) Patient's preference.
(2) Physician's order.
3. An evaluation visit and patient assessment must be
performed by the nurse to:
a. Assess the need for midline catheter
placement.
b. Assess peripheral vasculature for vein large
enough to accommodate the
selected/appropriate catheter size.
c. Recommended dwelling time for a midline
catheter is 2-4 weeks. If the line is assessed
after 4 weeks and it is patent without problems
it can remain for a longer period of time (per RN
evaluation).
4. The length of a midline catheter is between 3 inches
and 8 inches with the tip usually residing below the
axilla and insertion site no more than 1.5 inches
above or below the antecubital fossa. (See
Administration of Intravenous Therapy in the Home
No. 9.01)
5. An extension set may be added and can be treated
as part of the catheter if added with sterile
technique.
6. The insertion of a midline catheter requires
adherence to strict sterile technique.
7. A patient may be accessed for a maximum of two
attempts, at any given time for the purpose of
inserting a midline catheter.
8. Midline catheters are never sutured in place.
Steristrips may be used to secure catheter.
9. Hemostats or any clamp with teeth or sharp edges
should not be used on the catheter.
10. Blood sampling is not recommended, but may be
performed on adult patients with a 20-gauge or
larger catheter, using a syringe. (NO
VACUTAINERS)
11. Blood pressure cuffs or tourniquets should not be
placed on the arm where the catheter is inserted.
12. A post-insertion evaluation and dressing change is
performed within 24-48 hours of insertion of a
catheter.
13. Prior to insertion, instruct the patient in:
a. Sterile and aseptic principles.
b. Purpose of midline catheter insertion.
c. Procedure for placement/insertion.
d. Follow-up plan.
EQUIPMENT:
Venous access device (appropriate gauge for specific
therapy)
Insertion kit
OR
Sterile gloves (2 pair)
Alcohol applicator (wipe/swab/disk/ampule)
Antimicrobial applicator (wipe/swab/disk/ampule)
Tourniquet
Sterile drapes
Sterile tape or steri-strips
Transparent permanent adhesive dressing
Heparin solution (100 units/cc, or as prescribed)
Towel roll, if applicable
Mask (2)
Protective eye wear
Disposable apron, if applicable
Puncture-proof container
Impervious trash bag
PROCEDURE:
1. Adhere to Universal Precautions.
2. Explain the procedure and purpose to the
patient/caregiver. Obtain informed consent, if
needed.
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